Most patients with delayed presentation of traumatic diaphragmatic hernias recover and remain symptom free after the immediate posttraumatic period. This period may vary, from months to years, the longest reported being 28 years. Patients usually present with an acute crisis and do not stress the history of trauma. Rupture of the diaphragm leads to herniation of abdominal organs into the chest. Common viscera herniated include the stomach (most common), colon, small bowel, and spleen. The symptoms may be those of classic intestinal obstruction with abdominal pain and distention, vomiting, and air fluid levels on abdominal radiographs or upper abdominal and/or chest pain with vomiting and dyspnea. The differential diagnosis includes cholecystitis, pancreatitis and perforation of a peptic ulcer, myocardial infarction, pneumonia, or even hydropneumothorax. Clinical findings confirming the diagnosis include respiratory distress, decreased breath sounds on the affected side, aspiration of abdominal contents on insertion of a chest tube, auscultation of bowel sounds in the chest, paradoxical movement of the abdomen with breathing, and/or diffuse abdominal or chest pain. The diagnosis may be missed during first evaluation (in up to 14.6% of the cases4), resulting in chronic diaphragmatic hernia and/or strangulation.